Until relatively recently, the prevailing view was
that ADHD was a disorder of childhood that rarely persisted into the
adult years. Studies conducted over the past 10 years, however, have
indicated that this is not correct, and that many children with ADHD
continue to struggle with the condition beyond adolescence and into
their adult years.
As the awareness of ADHD as a long-term condition has increased, so has
the need for studies of ADHD in adult populations. Given that
social relationships is an area where children with ADHD often
struggle, it is especially important to examine interpersonal
functioning in adults with ADHD, particularly in regards marital and
family relationships, the most important relationships in adults'
lives. Because research on adults with ADHD has lagged far behind
investigations of children, however, there has been only a single prior
study of this topic. Although this study was limited by a small
sample size, there was a trend for adults with ADHD to report lower
levels of marital satisfaction.
A study published in a recent issue of the
Journal of Attention Disorders titled "The Marital and
family functioning of adults with ADHD and their spouses" (JAD, 8,
1-10) provides an interesting new examination of this issue. In
this study, the authors sought to gain a better understanding of the
functioning of clinic-referred adults with ADHD within their family
context. The goals of the authors were three-fold.
First, they examined the marital adjustment and family functioning of
married adults with ADHD. They hypothesized that adults with ADHD
would report lower satisfaction with their marital and family
relationships than comparison adults who did not have the disorder.
Second, the authors examined the adjustment of the spouses of adults
with ADHD. The authors expected that these adults would report
lower levels of satisfaction with their marriage and family life than
adults whose spouse did not have ADHD.
Finally, the authors were interested in learning more about the
experience of being married to an adult with ADHD. In particular,
they wanted to learn how spouses felt that difficulties related to
their partner's ADHD affected them and what adjustments they had made
because of this.
Participants were 33 adults with ADHD (21 male and 11 female) who had
been referred to an adult ADHD specialty clinic located in a university
affiliated hospital, 32 of their spouses, 26 comparison adults without
ADHD who were recruited from the community, and the spouses of these
adults. The adults with ADHD represented all adults participating in a
larger study of ADHD in adults who were married; this was 40% of that
larger study population. Approximately 80% of couples in both
groups had children. Couples in the study had been married for an
average of 11 years.
All participants with ADHD had undergone a rigorous diagnostic
evaluation to confirm that ADHD was an appropriate diagnosis. (As
an interesting sidelight, nearly 40% of adults who presented at this
clinic because they believed they had ADHD were not diagnosed with ADHD
following the evaluation. This highlights the limitations of
"self-diagnosis" in adults and the value of a comprehensive evaluation
prior to initiating ADHD specific treatments.) Volunteers from
the community were carefully screened to make sure that they did not
have the disorder.
Participants completed the Dyadic Adjustment Scale, a 32-item measure
that includes subscales intended to assess the degree of satisfaction,
affection, cohesion, and distress that adults experience in their
marital relationship. To assess perception of family functioning,
they completed the 60-item Family Assessment Device. The aspects
of family functioning assessed by this measure include problem solving,
communcation, emotional responsiveness, emotional involvement,
communication, and behavior control.
In addition to these measures, spouses of adults with ADHD were asked
several additional questions about the impact their partner's ADHD
symptoms had on their lives. The questions asked included the
following:
- "What are your concerns about your spouse's behavior?"
- "How do your partner's ADHD symptoms affect you?"
- "Do you have any complaints with regard to your spouse?"
- "Do you compensate for your partner's difficulties? If yes,
how?"
Unfortunately, these same questions were not asked of spouses married
to partners without ADHD, so the ability to compare responses across
the groups is not present.
RESULTS
"How do adults
with ADHD and their spouse perceive their marital relationship?"
As predicted, adults with ADHD reported significantly poorer marital
adjustment than non-ADHD adults across a range of areas.
Specifically, they reported lower overall levels of satisfaction, less
cohesion, lower levels of affection, and lower levels of
consensus. In addition, their total scores on the scale were over
4 times more likely than scores of comparison adults to fall in the
"maladjusted range", indicative of significant difficulties in the
marital relationship.
Spouses of adults with ADHD reported lower levels of overall marital
satisfaction than other spouses, and were more likely to have overall
scores on the Dyadic Adjustment Scale that fell in the maladjusted
range.
"How do adults
with ADHD and their spouse perceive their family relationships?"
In comparison to other adults, adults with ADHD reported less
satisfaction with their family relationships. The specific areas
of family life that they rated more negatively were emotional
involvement, communication, problem solving, and family roles.
Their spouses, however, did not report lower satisfaction with family
life than spouses of adults without ADHD.
"Do adults with
ADHD perceive their marital and family life differently than their
partner?"
The researchers also examined how satisfaction with marital and family
life compare for adults with ADHD and their spouse.
Interestingly, adults with ADHD were less satisfied with their marital
relationship than their partner. They were also less satisfied
with the quality of their family life than their partner. In
contrast, in couples where neither partner had ADHD the level of
satisfaction with marital and family life reported by each partner did
not significantly differ.
"What complaints
and concerns do spouse's of adults with ADHD express and how do they
compensate for their partners difficulties?"
Thirty-one of 32 spouses of an adult with ADHD reported that their
partner's behavior interfered with their functioning in at least one
domain. The most frequently reported complaints and concerns fell
within the domains of general household organization/time management
(92% of spouses reported problems with their partner in this area),
child rearing (55% reported problems in this domain), and communication
and/or the marital relationship (54% reporting problems).
Within the general household domain, the complaints frequently reported
included not initiating or completing household tasks/chores, excessive
procrastination, and losing track of time/having a poor sense of
time.
To compensate for their partner's difficulties in these areas, many
spouses reported that they had taken on the task of keeping track of
appointments for their spouse and providing them with frequent
reminders about what they needed to get done. They also reported
taking on a greater share of organizational tasks at home including
completing almost all of the chores and cleaning up after their partner.
In the child-rearing domain, spouses frequently expressed concerns that
their partner was easily frustrated with the children, lost their
temper too quickly, and was inconsistent with discipline. In
addition, adults with ADHD were described by their partner as often
forgetting important child rearing tasks, and as focusing on being the
"entertainment parent" rather than helping with discipline. Poor
judgment in the form of excessive rough play and impulsive decisions
were also noted.
To compensate for what they perceived as their partners' difficulties
with child rearing, spouses reported taking care of nearly all
child-related tasks and activities. This included car pooling,
keeping track of their child's appointments and activities, helping
with homework, and communicating with their child's teachers.
Many reported having to protect their children from their partner's
blow-ups and having to settle the children down after their spouse had
"wound them up".
In the communication/marital relationship area, the concerns reported
included frequent arguments, misunderstandings, and lack of
support. Spouses complained that their partner often failed to
follow though on commitments/promises they had made. Problems
with intimacy and difficulty with expressing feelings were also noted.
Nearly 40% of spouses of adults with ADHD reported that their partner
had work/school difficulties because of their symptoms and also had
trouble with financial management. In the work/school domain, the
problems described included lack of organization, difficulty getting
along with co-workers, and appearing lazy. To help their spouse,
partners often took on a secretarial role, by managing customer
contacts and organizing their spouse's work. Several noted that
they had quit their own job in order to help their partner.
When the ADHD adult was a student, spouses described helping with
reading and writing, explaining concepts, organizing homework, and
making sure that assignments got turned in. Interestingly, this
sounds very similar to what many parents of children/adolescents with
ADHD do to help their child.
SUMMARY AND IMPLICATIONS
Results from this study indicate that, on average, adults with ADHD are
less satisfied in their marriage than our other adults, less satisfied
in their marriage than their partner, and less content with various
aspects of their family life.
The experience of spouses with ADHD is somewhat different.
Compared to adults whose partner does not have ADHD, they also report
lower levels of overall marital satisfaction. They are, however,
more satisfied than their partner and are also not less happy about
their family life than other adults.
Particularly interesting were the concerns that spouses of adults with
ADHD expressed about their partner. Virtually all spouses noted
that their partners' symptoms adversely impacted at least one important
aspect of marital/family life and that they had developed a number of
strategies to compensate for this. The authors note that
"...although it was not surprising that more than half the spouses
compensated for difficulties with general household organization/time
management and child rearing, the fact that many of them also
compensated for their partners' difficulties at work or school was
unexpected." Spouses frequently took on important roles in
organizing their partner's work life and the financial management of
their partner's business. Of perhaps greater concern are reports
of having to frequently protect the children from partner's emotional
outbursts.
Although the results of this study are quite interesting, it is
important to note several limitations. First, the sample size is
relatively small, and replicating the findings with a larger sample
would be a useful next step. In addition, to learn whether the
findings reported here are unique to ADHD, it would be important to
include couples in which one member has a different psychiatric
disorder.
Second, as noted previously, the authors did not interview spouses of
partners without ADHD about their concerns in the marriage. Thus,
although the qualitative interview results are perhaps the most
interesting data reported, these data should be interpreted cautiously
because there is no basis for comparing the interview results to what
is reported in other couples.
Third, while not a limitation of the study, it is important to
emphasize that not all adults with ADHD were dissatisfied in
their marriage and family life. In addition, although nearly all
spouses reported that their partner's ADHD symptoms created some
difficulties in marital/family life, there was wide variability in the
difficulties reported. Thus, one should not interpret these
results as indicating that all marriages where one partner has ADHD are
troubled and that all adults with ADHD are unable to fulfill important
obligations as a parent and partner. For example, only 55% of spouses
reported specific concerns about their partner's child rearing and with
communication in the marital relationship. Thus, many spouses did
not report their partner as struggling in these areas.
Overall, this study sheds important new light on how adults with ADHD
and their spouses experience their marital and family
relationships. The authors suggest that their findings underscore
the need for comprehensive evaluations of ADHD adults to include
screenings of marital adjustment and family functioning from the
perspective of both partners in the marriage, and for interventions to
target the areas of concerns that are indicated. This seems like
a very sensible recommendation, and future work that builds on this
interesting study, and which examines ways to address marital and
family difficulties in adults with ADHD, will be a welcome addition to
the literature.